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Conditioning Regimens

Reduced-intensity vs myeloablative conditioning allogeneic hematopoietic SCT for patients aged over 45 years with ALL in remission: a study from the Adult ALL Working Group of the Japan Society for Hematopoietic Cell Transplantation (JSHCT)

Bone Marrow Transplantation volume 48, pages 1389–1394 (2013)Cite this article

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Abstract

In this study, outcomes for 575 adult ALL patients aged ⩾45 years who underwent first allo-SCT in CR were analyzed according to the type of conditioning regimen (myeloablative conditioning (MAC) for 369 patients vs reduced-intensity conditioning (RIC) for 206 patients). Patients in the RIC group were older (median age, 58 vs 51 years, P<0.0001). There were no statistically significant differences in 3-year OS, disease-free survival (DFS) and non-relapse mortality (NRM): 51% vs 53%, 47% vs 39% and 38% vs 36%, respectively. Multivariate analysis showed that CR2 and HLA mismatching were associated with poor OS (P=0.002 and P=0.019, respectively). HLA mismatching was associated with lower rate of relapse (P=0.016), but was associated with higher rate of NRM (P=0.001). RIC was associated with good OS and DFS in patients who received HLA-mismatch transplantation and were aged ⩾55 years compared with MAC by multivariate analysis for each event with interaction (hazard ratio (HR) and 95% confidence interval 0.35 and 0.15–0.81, P=0.014 for OS and 0.36 and 0.16–0.81, P=0.013 for DFS). Therefore, patients ⩾55 years of age with HLA-mismatch transplantation should be candidates for RIC rather than MAC.

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Acknowledgements

This study was supported in part by a Grant-in-Aid from the Ministry of Health, Labor and Welfare of Japan and a Japanese Grant-in-Aid for Scientific Research.

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Author notes

  1. J Tanaka

    Present address: Department of Hematology, Tokyo Women's Medical University, Tokyo, Japan.,

Authors and Affiliations

  1. Department of Hematology and Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    J Tanaka

  2. Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan

    H Kanamori

  3. Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    S Nishiwaki

  4. Division of Hematology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan

    K Ohashi & H Sakamaki

  5. Department of Hematology, Toranomon Hospital, Tokyo, Japan

    S Taniguchi

  6. Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan

    T Eto

  7. Department of Hematology, Osaka City University Graduate School of Medicine, Osaka, Japan

    H Nakamae

  8. Department of Hematology, Kobe University Graduate School of Medicine, Kobe, Japan

    K Minagawa

  9. Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

    K Miyamura

  10. Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan

    Y Morishima

  11. Department of Pediatric Hematology/Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

    K Kato

  12. Department of Hematopoietic Stem Cell Transplantation Data Management/Biostatistics, Nagoya University School of Medicine, Nagoya, Japan

    R Suzuki

  13. Center for Translational Research, Hokkaido University, Sapporo, Japan

    N Nishimoto

  14. Translational Research and Clinical Trial Center, Hokkaido University Hospital, Hokkaido University, Sapporo, Japan

    K Oba

  15. Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan

    N Masauzi

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  1. J Tanaka
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  2. H Kanamori
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  5. S Taniguchi
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  6. T Eto
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  7. H Nakamae
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  8. K Minagawa
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  9. K Miyamura
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  10. H Sakamaki
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  11. Y Morishima
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  16. N Masauzi
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Correspondence to J Tanaka.

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Author Contributions

JT and NM designed the study and prepared the manuscript; NN and KO performed the statistical analysis; SN, KO, ST, TE, HN, Ke M, Ko M, HS, YM, KK and RS participated in interpretation of data and approval of the final manuscript.

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Tanaka, J., Kanamori, H., Nishiwaki, S. et al. Reduced-intensity vs myeloablative conditioning allogeneic hematopoietic SCT for patients aged over 45 years with ALL in remission: a study from the Adult ALL Working Group of the Japan Society for Hematopoietic Cell Transplantation (JSHCT). Bone Marrow Transplant 48, 1389–1394 (2013). https://doi.org/10.1038/bmt.2013.68

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